Friday, April 7, 2017

Billy Wynne[1],
writing for the Health Affairs Blog has done a wonderful job of outlining some
of the essential ingredients necessary to address the national health care insurance
issue. The posting on April 4, 2017, entitled, “What
Now?: A Four Step Plan For Bipartisan Health Reform” is precisely what
I have been saying is needed for Democrats to use in the development of an
“Affordable Care Improvement Act” that could provide a sensible alternative to
the GOP cobbled up, disastrous proposal known as the American Health Care Act (AHCA)[2]. See my March 27, 2017, post, “Democrats Could Lead The Bipartisan Revolution.”

I have been
advocating for Democrats to take the lead now that the GOP efforts have failed
and the President has declared:

“I
think the losers are Nancy Pelosi and Chuck Schumer, because now they own
Obamacare. They own it -- 100 percent own it.” And this is not
a Republican healthcare, this is not anything but a Democrat healthcare. .
.”

Following
the GOP debacle[3], I said Democrats need to develop
the "Affordable Care Improvement Act", designed to do what needs to
be done to make the Affordable Care Act work better and introduce it in the
House and Senate with 100% of the Democrats in both chambers supporting it.
Simultaneously, they need to launch a massive public education and media
campaign comparing the Republican and Democratic alternatives.

It is no
wonder that the GOP is still divided on Healthcare? The House Freedom Caucus'
30+ votes will continue to block any effort that Speaker Ryan proposes. The GOP
is getting so desperate to just pass something that they have now discounted
rationale health care reform. The HFC's basic strategy is to reduce insurance
costs for their constituents; an admirable goal, and they have found a
guaranteed way to do it. Their "Plan" is don't cover anything
including preexisting conditions. That should definitely reduce costs.

One can
only imagine that eliminating coverage for these essential health care services
would definitely reduce costs. Speaker Ryan said, "Instead of imposing
arrogant and paternalistic mandates [like coverage for the above listed items],
it [GOP plan] would increase choice and competition, creating a vibrant market
where every American will have access to quality, affordable coverage."

Democrats
need to step it up, lead the way, and not just be the party of “No” opposing
all of the iterations of the GOP’s American Health Care Act. Instead of trying
to get a few Democrats to sign on to a fatally flawed GOP proposal, why don’t
Democrats turn the tables, propose a plan that makes sense and get 25-30
moderate, “Main
Street” or “Tuesday
Group” Republicans to sign on.

Billy Wynne
has now provided the substance of what is needed in a Democratic alternative.
Below is an extremely brief overview, but I highly encourage reading Mr.
Wynne’s complete proposal. Some of this is fairly technical, but I am including
it to illustrate the extent of Affordable Care Act (ACA) [Patient Protection and Affordable Care Act (PPACA)
2010 HR3590, or Affordable Care Act (ACA) for short] improvement ideas that exist which
could be advanced.

Step 1 – Enhance The Individual
Market: Wynne
lays out a number of critical “mechanical options” to enhance markets and
maintain the basic elements of the existing Affordable Care Act including
continued funding the cost-sharing subsidies currently available to individuals
in the exchange markets; actively marketing and supporting enrollment in
available coverage options; and more substantial changes that would improve
competition and reduce costs. Some options suggested have strong conservative
support.

One
major suggestion is that in lieu of the initial GOP approach of delivering tax
credits of equal value to individuals at different income levels, the existing
subsidy structure could be expanded to all households so that none are required
to pay more than 9.5 percent of their income for coverage, which de facto
phases out the subsidy at high income levels. While ensuring affordability for
the middle class, this will also entice a broader array of consumers to get
into the market.

Other
significant suggestions include establishing default enrollment, perhaps into
the lowest cost plan available with an opportunity to opt out; and ending the
now four-year extension of plans that do not comply with the consumer
protections enacted in the ACA.

Step 2 – Rationalize The Employer
Market: The majority of
Americans with health insurance acquire it via their employer -- two key
changes could be enacted to improve that market’s condition. First, the
so-called “family glitch,” which denies subsidies to family members if one of
them has access to relatively affordable individual coverage from
their employer, should be fixed to allow those family members to acquire
subsidized coverage elsewhere. Second, access to the small business tax credits
in the ACA could be expanded to assist more workers in this market.Allow
small business employees to be merged into the individual market completely
over time and provide large employers greater opportunity to provide their
employees a fixed allotment with which they can purchase insurance in a private
exchange. Finally, addressing the “elephant in the room” “. . .by capping or
eliminating the “around four trillion dollars over ten years” of tax
exclusion for employer sponsored insurance.

Step 3 – Embrace Medicaid & Step
4 – Don’t Forget The Big Picture: Wynne says “It’s time to drop the ideological divide over Medicaid, a
program that covers 74 million Americans who truly have nowhere else to
turn.” He also reminds that health insurance coverage is really just a method
for helping consumers address the underlying issue: their health -- we need
focus on patients and the providers who take care of them.

Yes, there
are problems with House leadership putting such an alternative bill up for a
vote, but that's why an aggressive education & media campaign is needed.Wynne concludes:

“The
bottom line is that there are a host of policies that lawmakers and regulators
can embrace to start drastically improving the condition of our health care
system. This will not be easy, nor will it happen quickly. Policymakers of all
political stripes can come together now, though, to begin the arduous process
of identifying evidence-based solutions and building the necessary consensus to
enact them. It’s a winning strategy for politics and for the public.”

While I agree, I don’t think the current
GOP leadership or Republican base has the desire or will to lead this effort.
They are too wedded to the 7-year mantra of “Repeal & Replace Obamacare.”
That’s why Democrats must take the lead.

#BetterGovmt

--------------------------------------------------------------------

[1]Billy Wynne, J.D., is the Managing Partner of TRP
Health Policy. A division of the Washington
government relations firm Thorn Run Partners, TRP Health Policy combines
industry-leading, actionable analysis and insight with sophisticated, informed
advocacy to help healthcare organizations solve challenges and capitalize on
opportunities in the Federal policy space.

TRP Health Policy is also home to Policy Hub, an
online portal and daily digest delivering in-depth intelligence on every
important regulatory and legislative development impacting healthcare.

Previously, Billy served as Health Policy Counsel to
the U.S. Senate Finance Committee. He received his B.A. from DartmouthCollege
and his law degree from the University
of Virginia.

May 25, 2017: “Obviously we’re all united in opposition to Trumpcare. That’s easy. People know what we’re against, but we want to promote more what we are for.” A quote from Rep. John Conyers (D-Mich.), who has been introducing single-payer legislation (“Medicare for all.”) since 2003. House Democrats See Medicare for All as Answer to ‘Trumpcare’. H.R.676 now has 111 Democratic co-sponsors. There are 193 Democrats in the House.